Screening for Adverse Childhood Experiences in Children: A Systematic Review

Pediatrics. 2022 Feb 1;149(2):e2021051884. doi: 10.1542/peds.2021-051884.


Context: Adverse childhood experiences (ACEs) are associated with increased risk of poor mental health outcomes. Although there is interest in screening for ACEs for early identification and intervention, it is not known whether screening improves outcomes for children.

Objective: To systematically review whether screening for ACEs in children leads to an increase in (1) identification of ACEs, (2) referrals to services, (3) increased uptake of services, and (4) improved mental health outcomes for children and parents.

Data sources: Ovid Medline, PsycINFO, CINAHL, and Center for Clinical and Translational Research electronic databases were searched between 2009 and 2021.

Study selection: Studies were included if researchers screened for current ACEs in children aged 0 to 12 years and they had a control comparison.

Data extraction: Information was extracted, including study characteristics, sample demographics, screening tool characteristics, referral rates to services, uptake rates, and mental health outcomes.

Results: A total of 5816 articles were screened, with 4 articles meeting inclusion criteria. Screening for ACEs increases identification of adversity and may increase referrals to services. There are limited data about whether this leads to an increase in referral uptake by families. There are no reported data addressing mental health outcomes.

Limitations: There are few published control trials of moderate quality.

Conclusions: There is limited evidence that screening for ACEs improves identification of childhood adversity and may improve referrals. If we are to realize the hypothesized benefits of ACEs screening on child and parent mental health, it is essential to understand the barriers for families taking up referrals.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adverse Childhood Experiences / psychology*
  • Adverse Childhood Experiences / trends*
  • Child
  • Child, Preschool
  • Humans
  • Infant
  • Infant, Newborn
  • Mass Screening / methods*
  • Mass Screening / trends*
  • Mental Health*
  • Randomized Controlled Trials as Topic / methods